Healthcare Provider Details

I. General information

NPI: 1528398641
Provider Name (Legal Business Name): KELLY KEMP STUART PHARM.D., BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LEE BRANCH LN
BIRMINGHAM AL
35242-7298
US

IV. Provider business mailing address

1100 LEE BRANCH LN
BIRMINGHAM AL
35242-7298
US

V. Phone/Fax

Practice location:
  • Phone: 662-719-4279
  • Fax: 205-995-5836
Mailing address:
  • Phone: 662-719-4279
  • Fax: 205-995-5836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberE-09229
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberE-09229
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberE09229
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: